CABG Improves Survival in Diabetic Patients with Heart Disease

According to an article
in The Annals of Thoracic Surgery, in diabetic patients with heart disease,
coronary artery bypass grafting (CABG) surgery is better than stenting
(percutaneous coronary intervention, PCI) at improving their long-term survival
and reducing the risk of adverse complications.

Diabetic patients are
two to four times more likely to have heart disease as compared to
non-diabetics. Approximately 65 percent of these patients will die from heart
disease. Those who require medical intervention should talk to their physicians
to determine the best possible treatment option. This study indicates that
bypass surgery is more effective for this patient population as compared to
stenting.

The study was conducted
by Paul Kurlansky, MD, from Columbia University Medical Center in New York and
his colleagues who examined data on all patients undergoing CAPG or PCI for
coronary artery disease. They compared 240 well-matched patients from each
treatment group. The results of the study show that mortality was more common
in patients who received PCI that those who underwent CABG. In addition,
patients in the PCI group had a higher risk of non-fatal heart attack and a
need for revascularisation.

Dr. Kurlansky points out that CABG is more
effective in diabetic patients because it addresses the entire downstream
circulation and is a more complete solution as compared to PCI which addresses
only localised lesions.

“Unlike a lot of other
studies that focus on select groups of patients who receive special therapies,
our results reflect a ‘real world’ picture of contemporary medical practice and
are broadly applicable to the general population of diabetic patients with
severe coronary artery disease,” said Dr. Kurlansky.

The study did not
examine the long-term risk of stroke in the two patient groups and the researchers
note that this could possibly be an area of further investigation.

In an accompanying
commentary, Robert F. Tranbaugh, MD, from Mount Sinai Beth Israel in New York,
also appreciated these findings and praised the efforts of Kurlansky et al in
defining the optimal treatment of diabetic patients with coronary artery
disease. He also emphasised that these findings should be incorporated into the
management of diabetic patients with multi-vessel heart disease and cardiac
surgeons and cardiologists should work together to seek the most durable and
the safest treatment option for these patients.

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